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STATE OF CALIFORNIA <br /> ORIGINAL THE RESOURCES AGENCY ofNah�oZ�] Do not fill to <br /> -File with DWR DEPARTMENT OF WATER RESOURCES <br /> WATER WELL DRILLERS REPORT N0. 304331 <br /> tice of Intent No. 2165M State Well No. <br /> ZI,cul Permit No. or Date Other Well No. <br /> (1) OWNER: Name MCkJ and Cil QMU= (12) WELL LOG: Total depth GO _ ft. Completed depth 60 ft. <br /> Address from ft. 1 to60 ft. Formation (Describe by color,character,size or material) <br /> ' City Sammurntn CA _ _....._Zip 95853 _ <br /> (2) LOCATION OF WELL (See instructions): - See Bore Ebie Log <br /> County—Sm 171 Owners Well Number N1 — <br /> ' Well address if different from above Blvd. C — <br /> Township Range _6)i_ _ ----section 2 <br /> Distance from cities,roads, railroads, fences,etc. tel 12' SOUtri — <br /> v <br /> (3) TYPE OF WORK: J r <br /> New Well N Deepening ❑ \� '` V <br /> SEP Figmms 1 2, arid 3 Reconstruction ❑ — ^ <br /> Reconditioning ❑ <br /> Horizontal Well ❑ <br /> Destruction ❑ (Describe <br /> destruction materials and pro- n^\\ n <br /> cedures in Item 12) U 4 <br /> (4) PROPOSED US <br /> ' Domestic <br /> Irrigation <br /> Industrial � Cl <br /> M Test Well <br /> \V\`` , <br /> } <br /> Munici <br /> El <br /> ' WELL LOCATION SKETCH e ibe) -'1WEM Lic# 513857 the work <br /> (5) EQUIPMENT: �fik CRAY CK: r <br /> Rotary 2 Reverse ❑ l� �� N°� �5,+\ ` \�1,e� desbxied � lZamtior <br /> ' cable C Air ❑ �_ eof boreIkil LiC # 401 S30 <br /> Other ❑ Rucke m <br /> ' (7) CASING INSTALLED: (8) PERk A I = u <br /> (( 1„ � tz�ni.e.pipe inside of 8 hollow st-.an <br /> Steel ❑ Plastic Na2 retie Ty of!tqoant4ion or size of t ' <br /> From Di . Gage or <br /> ft. f Wall <br /> 0 30 Srh 40 30 0_01" _ <br /> U <br /> (9) WELL SEAL: _ <br /> Was surface sanitary sea[provided? Yes Rl No ❑ If yes,to depth ft. <br /> Were strata sealed against pollution? Yes ® No ❑ Interval 1 '_23-5' ft. — <br /> Methodofsealing 1 ' rultit Cenlea '- ' bgmtrynifM P214Wk started 11/10 1989— Completed—1140 i98g— <br /> (10) WATER LEVELS: q WELL DRILLERS STATEMENT: <br /> Depth of first water,if known d&A9' ft. <br /> This well was i5� <br /> my 'deet' d this report is true to the <br /> Standing level after well completion 46-4:7' ft. best of my knol ie <br /> (11) WELL TESTS: Signed <br /> Was well test made? Yes ❑ No [R If yes,by whom? g <br /> of test pump ❑ Bailer ❑ Air lift ❑ NAM YtT l Jack <br /> h to water at start of test ft. At end of test ft. (Person,firm,or corporation}{Typed or printed) <br /> ' rscharge gal/min after hours Water temperature Address <br /> Chemical analysis made? Yeas N No ❑ If yes,by whom? City Wxdl and CA Zip --95695 <br /> Was electric lex{made Yes ❑ No ® If yes,attach copy to chis report License No, 511897 Date of this report 1919W C) <br /> ' pyyp 188 tREV. 12-881 <br /> IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM 86 96335 <br />